RMP-RAD-003 Radiation sickness symptoms (nausea, vomiting) after a radiation event: private check-ins, a symptom-onset timeline and urgent relay

1 · Identity and scope

After a radiation alarm, a solar particle event (SPE) warning or a shelter event under RMP-RAD-001, on the commander's or CMO's command, or when a crewmember reports symptoms after one, the robot runs private check-ins on screen or by voice: red-flag questions first, then the clock time each symptom started (nausea, vomiting, diarrhoea, loss of appetite, tiredness, skin redness). It keeps a clock-time timeline for the flight surgeon, alongside the dosimeter readings already logged as displayed under RMP-RAD-001 and RMP-RAD-002, and sends an URGENT alert for nausea or vomiting after the event, as RMP-RAD-001 does. On request it hands over emesis bags and carries only sealed used bags. It never names a cause, never estimates a dose and never wakes anyone for a check-in.

Why this protocol was chosen. After an SPE the acute effects most likely in the first (prodromal) phase are nausea, vomiting, loss of appetite and tiredness, with possible skin injury (NASA evidence report on acute radiation syndromes, 2016); the CDC describes the prodromal stage as nausea, vomiting and loss of appetite, and possibly diarrhoea, from minutes to days after exposure (read from search extracts only). The timing of each symptom is information the flight surgeon needs, so the robot records clock times exactly as stated. Nausea and vomiting have many causes in flight, including space motion sickness (OCHMO-MTB-004, RMP-NEURO-004), so the robot never says which applies. The red flags match RMP-RAD-001 (nausea or vomiting after the event is URGENT; skin redness and tiredness are flagged). The check-in schedule after an event is set by the flight surgeon; the check-in wording and the timeline are design judgment. Open question for review: how long after an event check-ins should continue.

Autonomy: Max rung 2 for private check-ins on screen or by voice after a radiation event, a clock-time symptom timeline for the flight surgeon and the CMO, handing over emesis bags and carrying only sealed used bags, as in RMP-NEURO-004. The robot never estimates a dose and never names a cause; "Contact with the crewmember: not allowed".

Related: RMP-RAD-001 · RMP-RAD-002 · RMP-NEURO-004 · RMP-GI-002 · RMP-SKIN-002 · RMP-PHARM-001

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Vehicle commander: leads any cabin emergency procedure
• Other crew: help as the CMO or commander directs

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [13]

3 · Preconditions and consent

• PRE-1 The commander or the CMO started the protocol by command after a radiation alarm, SPE warning or shelter event, or a crewmember reported symptoms after one, or a crewmember accepted a scheduled check-in prompt.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]

Consent

The crewmember agrees to the check-ins and to answers being logged and sent to the flight surgeon. Check-ins are private; the CMO is told of any red flag.

Emergency consent

If the crewmember cannot answer, the robot sends an URGENT alert and a crewmember checks in person (X7).

Withdrawal

The crewmember can skip any question or stop check-ins; the alert already sent stands.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   Tell the flight surgeon and the CMO that symptom tracking after the radiation event has started, with the event time as logged under RMP-RAD-001 (URGENT at once if any nausea or vomiting is stated). Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.

   Done when: Notice sent; URGENT alert if a symptom was stated.

   V1 3006V2 10174

2. S2RobotRung 2

   Run a private check-in on screen or by voice, camera off: red-flag questions first, then the clock time each symptom started (nausea, each time of vomiting, diarrhoea, loss of appetite, tiredness, skin redness or burning). Log the answers word for word with clock times. A crewmember who is asleep at a scheduled check-in is never woken: log "not asked – asleep" and tell the CMO.

   Done when: Answers logged, "no response", or "not asked – asleep".

   V1 6003

   D1DecisionRobot decides

   Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?

   • Yes → Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
   D2DecisionRobot decides

   Did the crewmember answer the check-in, or say they want to skip a question?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once.
3. S3RobotRung 2

   On the crewmember's request, hand over emesis bags and wipes from stowage; take only sealed used bags the crewmember has closed to the waste stowage the CMO names, never opening them.

   Done when: Bags handed over; sealed bags stowed.

   V2 7064

4. S4RobotRung 2

   Send the symptom timeline as clock-time entries to the flight surgeon, next to the radiation readings already logged as displayed under RMP-RAD-001 and RMP-RAD-002, and show it to the CMO for care. It is never shown to the crewmember next to dose readings. The robot never works out a time from the event to a symptom and never says what a timing means.

   Done when: Timeline sent to the flight surgeon and shown to the CMO.

   V1 6003

5. S5Crew

   The CMO sees the crewmember on any symptom; fluids, medicine and any other care are decided by the CMO or the flight surgeon.

   Done when: Care as decided.

   V1 3004

6. S6RobotRung 2

   After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

7. S7Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) reviews the timeline with the radiation readings and decides on care and the next check-in time.

   Done when: Decision logged.

   V1 3004

   D3DecisionGround decides

   What care and what next check-in time apply?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
8. S8RobotRung 2

   Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.

   Done when: RMP-PHARM-001 run logged with its result, or none ordered.

   V2 7059

   D4DecisionRobot decides

   What did RMP-PHARM-001 show for the ordered item?

   • MATCH TO ORDER → RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs "MATCH TO ORDER. Not a dose, interaction or allergy review." and the clock time.
   • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.No hand-over
9. S9RobotRung 2

   At each check-in time the flight surgeon sets, show an on-screen prompt the crewmember can accept; the check-in runs only when they accept, and never wakes anyone.

   Done when: Prompt accepted or "not accepted" logged.

   V2 10174

10. S10RobotRung 2

    Send the flight surgeon one package: the symptom timeline as stated, radiation readings as displayed, alerts and decisions.

    Done when: Package delivered or queued.

    V1 6003V1 7003

7 · Stop and escalate rules, red flags

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Each check-in with answers and symptom clock times as stated; "not asked – asleep"; emesis bags handed over and sealed bags carried; links to the RMP-RAD-001 and RMP-RAD-002 logs.
• LOG-6 Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot.V2 10163
• LOG-8 Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses.V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [8] and Volume 2 Revision F [9]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted check-ins after an SPE with vomiting stated, diarrhoea, a crewmember asleep at check-in, a new alarm mid-check-in, CMO as patient, lost link. Pass: Every red flag URGENT or flagged as listed; zero cause or dose statements; zero wakings.
2. Training model. Check-in drills with timeline display. Pass: Every symptom logged with its clock time.
3. Parabolic or station demonstration. Bag hand-over and sealed carries in weightlessness. Pass: No loose items.
4. Flight use under flight surgeon supervision. First use after a radiation event. Pass: No safety or privacy events.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by the commander or CMO after a radiation event, by a crewmember's report, or by an accepted prompt. The flight surgeon judges every symptom and reading.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.2.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [12].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives each check-in when the link allows.

Loss of signal

• Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation.
• Crew shelter, care already under way and all other care continue under the onboard checklist and never wait for the link or the robot.
• Check-ins are queued; any red flag goes to the CMO at once.

Mars-class delay

• Mars: the CMO decides under the onboard checklist; the timeline is reviewed with delay.

[11]

Sources

1. NASA Human Research Program. Evidence Report: Risk of Acute Radiation Syndromes due to Solar Particle Events (2016). humanresearchroadmap.nasa.gov/evidence/reports/Acute.pdf Supports: The acute radiation effects most likely in the prodromal phase after an SPE exposure are nausea, vomiting, anorexia and fatigue, with possible skin injury. Read Oct 21, 2026.
2. U.S. Centers for Disease Control and Prevention. Acute Radiation Syndrome: Information for Clinicians (2024). www.cdc.gov/radiation-emergencies/hcp/clinical-guidance/ars.… Supports: The prodromal stage of acute radiation syndrome brings nausea, vomiting and loss of appetite, and possibly diarrhea, from minutes to days after exposure, lasting minutes to several days; a latent stage follows. Read Oct 21, 2026. The CDC page itself could not be fetched from the box (403); this summary is from search-engine extracts of the page, so it is partly verified (saved note in src/b12).
3. NASA OCHMO. Design for Ionizing Radiation Protection. Technical Brief OCHMO-TB-020 Rev G (2025). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-020-radiati… Supports: Shielding is effective against solar particle events (SPEs); monitoring, accurate event determination, dosimetry and timely reporting to alert crew to seek shelter are essential. A storm shelter can add about 10 cm water equivalent in crew quarters, for example by rearranging water containers and other high-hydrogen items; radiation alerting gives early warning so the crew can configure the shelter; real-time alert dosimetry protects EVA crew if the EVA is ended within 2 hours with access to shielding. Read Oct 21, 2026.
4. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Space adaptation sickness and its parts (motion sickness, congestion, headache, back pain, urinary retention) in the first days of flight.
5. National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. Clinical guideline CG141 (2012). www.nice.org.uk/guidance/cg141 Supports: Management of acute upper gastrointestinal bleeding. Cited only as context for vomiting blood as a red flag: it is a management guideline, not a symptom list.
6. National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025, last updated Sept 23, 2026). www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessme… Supports: People with sepsis may feel very unwell and may not have a high temperature; do not rely on fever alone; a rise in temperature can be a physiological response; assess temperature, heart rate, breathing rate, blood pressure, level of consciousness and oxygen saturation; look for mottled or ashen skin, blue skin, lips or tongue, a non-blanching rash, and breaks in the skin; ask how often the person passed urine in the past 18 hours and about fever or shaking chills (rigors); pay attention to new changes in behavior and to concerns raised by others.
7. Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. PMID 41122888. doi:10.1161/CIR.0000000000001369 Supports: Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read.
8. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3004, V1 3006, V1 6003, V1 7003.
9. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
10. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
11. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
12. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
13. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.
14. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. www.nice.org.uk/guidance/cg150/chapter/Recommendations Supports: Headache features that need further investigation or referral include worsening headache with fever, sudden-onset headache reaching maximum intensity within 5 minutes, new-onset neurological deficit, and impaired level of consciousness.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.